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The Pediatric Heart Network Normal Echocardiogram Database Study had unanticipated challenges. We sought to describe these challenges and lessons learned to improve the design of future studies.
Challenges were divided into three categories: enrolment, echocardiographic imaging, and protocol violations. Memoranda, Core Lab reports, and adjudication logs were reviewed. A centre-level questionnaire provided information regarding local processes for data collection. Descriptive statistics were used, and chi-square tests determined differences in imaging quality.
For the 19 participating centres, challenges with enrolment included variations in Institutional Review Board definitions of “retrospective” eligibility, overestimation of non-White participants, centre categorisation of Hispanic participants that differed from National Institutes of Health definitions, and exclusion of potential participants due to missing demographic data. Institutional Review Board amendments resolved many of these challenges. There was an unanticipated burden imposed on centres due to high numbers of echocardiograms that were reviewed but failed to meet submission criteria. Additionally, image transfer software malfunctions delayed Core Lab image review and feedback. Between the early and late study periods, the proportion of unacceptable echocardiograms submitted to the Core Lab decreased (14 versus 7%, p < 0.01). Most protocol violations were from eligibility violations and inadvertent protected health information disclosure (overall 2.5%). Adjudication committee reviews led to protocol changes.
Numerous challenges encountered during the Normal Echocardiogram Database Study prolonged study enrolment. The retrospective design and flaws in image transfer software were key impediments to study completion and should be considered when designing future studies collecting echocardiographic images as a primary outcome.
We study the asymptotic behaviour of the powers of a composition operator on various Banach spaces of holomorphic functions on the disc, namely, standard weighted Bergman spaces (finite and infinite order), Bloch space, little Bloch space, Bloch-type space and Dirichlet space. Moreover, we give a complete characterization of those composition operators that are similar to an isometry on these various Banach spaces. We conclude by studying the asymptotic behaviour of semigroups of composition operators on these various Banach spaces.
There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group.
We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017–2018. We assessed the yields from different methods of recruitment and retention.
A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield.
Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.
Background: Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological entity associated with multiple etiologies including infection, metabolic, and epileptic disorders. We describe the case of a child with a reversible splenial lesion who presented with encephalopathy and prior history of episodic ataxia. Methods: A 3-year-old girl presented to the Stollery Children’s hospital with three days of respiratory symptoms followed by acute onset ataxia and encephalopathy. Blood, respiratory samples, and cerebral spinal fluid (CSF) were drawn to investigate for infectious, autoimmune, and metabolic causes. Magnetic resonance imaging (MRI) brain was done and repeated. Results: A respiratory panel tested positive for respiratory syncytial virus (RSV), enterovirus, and rhinovirus. CSF analysis revealed elevated white blood cell count (283). MRI brain demonstrated diffusion restriction involving the posterior body and splenium of the corpus callosum and bilateral middle cerebral peduncles, which resolved nine days later. The patient received high-dose steroids with gradual improvement in the encephalopathy and ataxia. Conclusions: This report contributes to the complexities in clinical understanding of RESLES, as it highlights a novel presentation with ataxia and encephalopathy. The patient’s diagnosis was complicated by previous ataxic episodes of unknown etiology, which allows further consideration of a metabolic or genetic ataxic syndrome and its relationship to encephalopathy.
Coronal Mass Ejections (CMEs) contribute to the perturbation of solar wind in the heliosphere. Thus, depending on the different phases of the solar cycle and the rate of CME occurrence, contribution of CMEs to solar wind parameters near the Earth changes. In the present study, we examine the long term occurrence rate of CMEs, their speeds, angular widths and masses. We attempt to find correlation between near sun parameters of the CMEs with near the Earth measurements. Importantly, we attempt to find what fraction of the averaged solar wind mass near the Earth is provided by the CMEs during different phases of the solar cycles.
We have studied three Interplanetary Coronal Mass Ejections (ICMEs) having clear signatures of magnetic cloud (MC) arrival at 1 AU and their associated solar sources during 2011 to 2013. Comparing the axial magnetic field strength (B0) of the near-Sun coronal flux-ropes with that of the MC at 1 AU, we have found that the average inferred value of B0 at 1 AU assuming the self-similar expansion of the flux-rope is two times smaller than the value of B0 obtained from the results of MC fitting. Furthermore, by comparing the initial orientation of the flux-rope near the Sun and its final orientation at 1 AU we have found that the three CMEs exhibited more than 80° rotation during its propagation through the interplanetary medium. Our study suggests that although the near-Sun magnetic properties of coronal flux-ropes can be used to infer the field strength of the associated MC at 1 AU, it is difficult to estimate the final orientation of the MC axis in order to predict the geo-effectiveness of the ICMEs.
Generally Coronal Mass Ejections (CMEs) are large eruptions of plasma and magnetic field from the Sun into interplanetary space. CMEs are most frequently associated with a variety of phenomena occurring in the lower corona before, during and after onset of eruption and generally are visible in coronagraph observation. Stealth CMEs do not obviously exhibit any of the low-coronal signatures (LCS) like solar flares, flows, jets, coronal dimmings or brightenings, filament eruptions or the formation of flare loop arcades. In this study, five stealth CMEs are selected using LASCO/SOHO CME catalogue and associated ICMEs (Interplanetaty CMEs) are identified using data from STEREO, ACE and WIND.
We have used the Coronagraphic and Heliospheric Imaging data from Solar TErrestrial RElations Observatory (STEREO) to observe a prominence which is erupted on June 7th 2011. This prominence is subjected to the morphological evolution of MRT instability from the lower solar corona upto the inter-planetary space. The unstable structures are converted into the bunch of localized plasma spikes due to the turbulent mixing, and propagate in the inter-planetary space upto 1 A.U.
Using HINODE/XRT, GOES, SDO/AIA observations, we study a compact C-1.4 class flare outside a major sunspot of AR 12178 on 4 October 2014. This flare is associated with a peculiar coronal jet, which is erupted in two stages in the overlying corona above the compact flaring region. At the time of flare maximum, the first stage of the jet eruption occurs above the flare energy release site, and thereafter in the second stage its magneto-plasma system interacts with the overlying distinct magnetic field domain in its vicinity to build further the typical jet plasma column.
It has been established that Coronal Mass Ejections (CMEs) may have significant impact on terrestrial magnetic field and lead to space weather events. In the present study, we selected several CMEs which are associated with filament eruptions on the Sun. We attempt to identify the presence of filament material within ICME at 1AU. We discuss how different ICMEs associated with filaments lead to moderate or major geomagnetic activity on their arrival at the Earth. Our study also highlights the difficulties in identifying the filament material at 1AU within isolated and in interacting CMEs.
An internationally approved and globally used classification scheme for the diagnosis of CHD has long been sought. The International Paediatric and Congenital Cardiac Code (IPCCC), which was produced and has been maintained by the International Society for Nomenclature of Paediatric and Congenital Heart Disease (the International Nomenclature Society), is used widely, but has spawned many “short list” versions that differ in content depending on the user. Thus, efforts to have a uniform identification of patients with CHD using a single up-to-date and coordinated nomenclature system continue to be thwarted, even if a common nomenclature has been used as a basis for composing various “short lists”. In an attempt to solve this problem, the International Nomenclature Society has linked its efforts with those of the World Health Organization to obtain a globally accepted nomenclature tree for CHD within the 11th iteration of the International Classification of Diseases (ICD-11). The International Nomenclature Society has submitted a hierarchical nomenclature tree for CHD to the World Health Organization that is expected to serve increasingly as the “short list” for all communities interested in coding for congenital cardiology. This article reviews the history of the International Classification of Diseases and of the IPCCC, and outlines the process used in developing the ICD-11 congenital cardiac disease diagnostic list and the definitions for each term on the list. An overview of the content of the congenital heart anomaly section of the Foundation Component of ICD-11, published herein in its entirety, is also included. Future plans for the International Nomenclature Society include linking again with the World Health Organization to tackle procedural nomenclature as it relates to cardiac malformations. By doing so, the Society will continue its role in standardising nomenclature for CHD across the globe, thereby promoting research and better outcomes for fetuses, children, and adults with congenital heart anomalies.
Avian tuberculosis is a chronic infectious disease caused by M. avium including four subspecies Mycobacterium avium subspecies avium; M. avium hominissuis; M. avium paratuberculosis; M. avium silvaticum. This disease is characterised by the formation of granulomatous lesions in viscera, a progressive weight loss and death. It can be transmitted to healthy birds in the flock, and occasionally to human beings. It is important to diagnose avian tuberculosis in order to prevent the spread of infection and epidemiology. This paper reviews the available techniques for the diagnosis of avian tuberculosis along with their pros and cons. The main problem in diagnosis is poor availability of samples due to infrequent shedding in faeces, pattern and colour of feathers, wattle and comb and lack of specific signs and symptoms. Any single technique is not effective in diagnosing the disease due to the lack of required sensitivity and specificity. Application of two or more techniques is not a feasible option in developing countries due to financial constraints. In the short term, more research is needed to develop multidisciplinary approaches which can help fully understand the aetiology and epidemiology of disease.
Mission simulation is a critical activity in the development and operation of Unmanned Aerial Vehicles (UAVs). It is important to ascertain the feasibility of a trajectory in a mission. In this work, an algorithm has been developed for feasibility study of a trajectory of a UAV using prescribed path optimal control through an inverse simulation method. This has been done under a Differential Algebraic Equations (DAE)/Inequalities (DAI) framework. The UAV model together with constraints is represented as a high index DAE system. The trajectory that UAV shall take is prescribed as one of the constraint equations. The solution for the DAE system is obtained using a variation of the alpha method that is capable of handling both equality and inequality constraints on system dynamics. The algorithm involves direct numerical integration of a DAI formulation in a time-stepping manner using a Sequential Quadratic Programming (SQP) solver that detects and satisfy active path constraints at each time step (mesh point). In this unique approach, the model and the constraints are always solved together. The method ensures stable solution at each time step, local minimum at each iteration of simulation and provides a regularised basis to the solver. A typical UAV trajectory has been simulated and demonstrated in this paper. This new approach can be used for path planning of UAVs before the actual control law is designed for flight control computer. Compared to other existing computationally intensive techniques, this approach is computationally simple, ensures continuous constraint satisfaction and provides a viable option for model predictive control of UAVs.
Diagnosis of Alzheimer disease is mainly clinical, based on longitudinal history and clinical criteria due to lack of specific biochemical tests and neuroimaging studies. Deficient central cholinergic activity of AD pathology is said to be reflected as decreased peripheral cholinergic activity. Assessing peripheral cholinergic function with pupillometer for diagnostic and prognostic purpose may be beneficial, as it may be a non-invasive, acceptable, and easily administered diagnostic tool if proven so.
This is a single point case control pilot study with sample size of 45 (25 AD patient and 20 controls). CAMDEX-R based interview, HMSE, and DSM-IV criteria were used for detailed assessment and diagnosis. The pupillometric parameters (Horizontal and vertical diameters of pupil) were measured by Oasis Colvard pupillometer (SKU-0401A) under three conditions namely after 5 minute of dark adaptation in dark room (PD-5min-DA i.e. Baseline PD); after 5 minutes (PD-5min-T) and 15 minutes (PD-15min-T) of instillation of 2–3 drops of 1.0% Tropicamide.
There was no difference in baseline pupil diameter (horizontal + vertical) of AD patients and age matched healthy controls. 1% tropicamide induced significant increment in pupil diameters from baseline to after 5 (‘PD-5min-T’) and 15 minutes (‘PD-15min-T’) of its instillation in both AD patients and age matched healthy controls. But tropicamide induced increment in pupil diameters were approximately equal in cases and controls.
The study did not find the role of 1% tropicamide induced pupillary hypersensitivity in AD patients for diagnostic purpose.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In healthy volunteers, light acting through serotonin pathways, decreases the threshold for sweet, but not salt taste; similar to SSRI paroxetine. In depressive disorders, there is deficiency of serotonin throughput, which is remedied by SSRI medications, and results in improvement in symptoms of depression. Thus, we report on taste thresholds before and after SSRI treatment.
To study the variation in thresholds for sweet with SSRI treatment in depressed patients in short- and long-term.
To compare the threshold for sweet (test) and salt (control) after 1 and 4 weeks of SSRI escitalopram therapy in depressed patients.
The project was approved by the institutional ethics committee. Following informed consent, depressed patients were initiated on escitalopram 10 mg/d (increased to 15 or 20 mg, if required after 1 week,). Taste recognition threshold, intensity and pleasantness were measured for sweet and salt. Each tastant was made −1 to −3 (100 mM–1 mM). Regional recognition thresholds were determined at the tip of the tongue using a cotton bud well soaked in the tastant.
Three males and 4 females of mean ages 39.1 years completed the study. There was significant shift to the left for sweet thresholds between days 0 and 7, and 7 and 28 [F(Dfn, Dfd) = 9.242 (4.162) P < 0.0001]. A similar shift to the left was seen for salt but day 7 only [F(Dfn, Dfd) = 6.213 (4.162)].
The increase in serotonin throughput as envisaged through SSRI treatment was paralleled by decrease in sweet thresholds.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Major depressive episode is having highest lifetime prevalence almost about 18% of all psychiatric disorder. W.H.O has ranked depression the 4th leading cause of disability worldwide and projects that it will be 2nd leading cause of disability by 2020. a number of consistent socio demographic correlates have also been found across countries. Here I am going to give a glimpse of MDD i.e. Depression excluding Bipolar Depression. Although It is the commonest psychiatric disorder, but attitude views about disease is very unscientific and biased.
Objective of this study was to know the views of relatives and friends about Depression, and acceptance of scientific view about depression.
As various survey reports are projecting that Depression will be the 2nd commonest cause of disability by 2020. So to create an awareness about depression and its modalities of successful treatments.
In this study, 96 patients were selected who had first episode of MDD without any discrimination of male and female. Their relatives and friends were categorized by their socioeconomic status. All of them were put on open questions regarding the disease.
Amongst them 10% were from upper socioeconomic status, 68% were from middle socioeconomic status and 22% were from lower socioeconomic status. Only 36% accepted depression as a disease, 45.8% suggested to change behavior and thought to get rid off disease; 8.2%believed the disease is due to devils spirit; 20.1% had no comments.
After explaining the disease psycho and pharmacopathology and showing the results of medicines 91.3% accepted it as a disease entity, 4.2% still in favor of devils spirit and 4.5% had no comments.
Disclosure of interest
The author has not supplied his/her declaration of competing interest.
Utilization of E.C.T. has diminished since the middle of 20th century but, inspite of widespread use of pharmacological agents for treatment of major psychiatric disorders, E.C.T. is still treatment of choice for patients with severe suicidal symptoms, catatonia and diseases resistant to various pharmacological agents. But inspite of its excellent effect in various psychiatric disorders, acceptance of E.C.T. is very poor in society.
Objective of this study was to know the attitude of attendants for E.C.T. and acceptance after detailed description of procedure and discussing merits and demerits of E.C.T.
As still it is the best treatment for certain psychiatric disorders, so to increase the awareness about its benefits and try to remove the negativity regarding E.C.T. in society.
In this study, 61 patients were randomly selected who had indication for E.C.T. without any discrimination of male and female. Their attendants were categorized by their socioeconomic status. All the attendants were asked open questions regarding their opinion for E.C.T. before taking consent.
Sixty patients were selected who had indication for E.C.T. and their attendants were asked to give their opinion for E.C.T. Amongst them 9.84% were from upper socioeconomic status, 68.86% were from middle socioeconomic status and 21.31% were from lower socioeconomic status. Only 11.48% had a positive attitude, 75.40% had a negative attitude and 16.39% had no comments.
After developing good rapport and confidence with attendants and detailed explanation of E.C.T. procedure, its merits and demerits 75.40% had given a positive attitude, 22.95% had given negative attitude and still 1.64% had no comments.
Disclosure of interest
The author has not supplied his declaration of competing interest.
Overuse of acetolactate synthase (ALS)–inhibiting herbicides in rice has led
to the evolution of halosulfuron-resistant rice flatsedge in Arkansas and
Mississippi. Resistant accessions were cross-resistant to labeled field
rates of ALS-inhibiting herbicides from four different families, in
comparison to a susceptible (SUS) biotype. Resistance index of Arkansas and
Mississippi accessions based on an R/S ratio of the lethal dose required for
50% plant mortality (LD50) to bispyribac-sodium, halosulfuron,
imazamox, and penoxsulam was ≥ 21-fold. Control of Arkansas, Mississippi,
and SUS accessions with labeled field rates of 2,4-D, bentazon, and propanil
was ≥ 93%. An enzyme assay revealed that an R/S ratio for 50% inhibition
(I50) of ALS for halosulfuron was 2,600 and 200 in Arkansas
and Mississippi, respectively. Malathion studies did not reveal enhanced
herbicide metabolism in resistant plants. The ALS enzyme assay and
cross-resistance studies point toward altered a target site as the potential
mechanism of resistance. Trp574–Leu amino acid substitution
within the ALS gene was found in both Arkansas and
Mississippi rice flatsedge accessions using the Illumina HiSeq platform,
which corresponds to the mechanism of resistance found in many weed species.
Field-rate applications of 2,4-D, bentazon, and propanil can be used to
control these ALS-resistant rice flatsedge accessions.